Third ventriculostomy through the fenestrated lamina terminalis during microneurosurgical clipping of intracranial aneurysms: an alternative to conventional ventriculostomy.

OBJECTIVE

Fenestration of the lamina terminalis (LT) is an alternative means of cerebrospinal fluid (CSF) drainage during acute or emergency surgery of ruptured intracranial aneurysms in patients with high-grade subarachnoid hemorrhage. External ventricular drainage allows drainage of CSF and also measurement of intracranial pressure after the surgery. Catheterization of the third ventricle via the fenestrated LT after clipping the aneurysm is an alternative to conventional ventriculostomies. This method has been used by the senior author (JAH) since 2001. The authors describe their experience with this technique, which can be used safely in selected cases of high-grade subarachnoid hemorrhage.

METHODS

Seventy-eight patients with aneurysmal subarachnoid hemorrhage underwent third ventriculostomy via the LT between March 2001 and December 2005. Clinical and radiological data of these consecutive patients were retrospectively reviewed.

RESULTS

There were no procedure-related complications. Eight patients (10%) later required a conventional ventriculostomy, 7 because of catheter occlusion and 1 because of catheter displacement. In 7 patients (9%), a positive CSF culture was found.

CONCLUSION

Ventriculostomy via the fenestrated LT performed during aneurysm surgery is a practical way for later CSF removal and intracranial pressure monitoring. The catheter can be applied via the same craniotomy without the need for an additional intervention. No procedure-related complications were observed in the present series. This technique can be suggested as a safe alternative to a classical ventriculostomy.